Background: Cardiac magnetic resonance tomography (CMR) is a new imaging technique capable of imaging the aortic valve with high resolution. We assessed the aortic valve area (AVA) in patients with aortic stenosis (AS) using CMR and compared the results to those obtained by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). Methods: Forty-two patients (36% female, 71 ± 8 years) symptomatic for AS underwent TTE followed by TEE to determine the AVA; the continuity equation was used with TTE and the planimetry technique with TEE. In 26 of these patients, the AVA was additionally obtained by CMR planimetry. Results: The mean AVA derived by TTE, TEE and CMR were 0.74 ± 0.27, 0.87 ± 25 and 0.97 ± 0.30 cm2, respectively. The mean absolute differences in AVA were 0.13 ± 0.19 cm2 for TTE vs. TEE, 0.21 ± 0.25 cm2 for TTE vs. CMR and 0.05 ± 0.11 cm2 for CMR vs. TEE. Conclusion: There is a good agreement between CMR and the echocardiographic determination of the AVA. If multicenter, large-scale studies confirm these observations, CMR could serve as a noninvasive alternative to TTE/TEE for the assessment of AVA in AS.

Lindroos M, Kupari M, Heikkila J, Tilvis R: Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993;21:1220–1225.
Selzer A: Changing aspects of the natural history of valvular aortic stenosis. N Engl J Med 1987;317:91–98.
Bonow RO, Carabello B, de Leon AC, Edmunds LH Jr, Fedderly BJ, Freed MD, Gaasch WH, McKay CR, Nishimura RA, O’Gara PT, O’Rourke RA, Rahimtoola SH, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Gibbons RJ, Russell RO, Ryan TJ, Smith SC Jr: ACC/AHA guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis 1998;7:672–707.
Rahimtoola SH: Severe aortic stenosis with low systolic gradient: the good and bad news. Circulation 2000;101:1892–1894.
Skjaerpe T, Hegrenaes L, Hatle L: Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation 1985;72:810–818.
Gorlin R, Gorlin SG: Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. Part 1. Am Heart J 1951;41:1–29.
Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, Grube E, Hanrath P, Maisch B, Dennig K, et al.: Safety of transesophageal echocardiography: a multicenter survey of 10,419 examinations. Circulation 1991;83:817–821.
Omran H, Schmidt H, Hackenbroch M, Illien S, Bernhardt P, von der Recke G, Fimmers R, Flacke S, Layer G, Pohl C, Luderitz B, Schild H, Sommer T: Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet 2003;361:1241–1246.
Kallmeyer IJ, Collard CD, Fox JA, Body SC, Shernan SK: The safety of intraoperative transesophageal echocardiography: a case series of 7,200 cardiac surgical patients. Anesth Analg 2001;92:1126–1130.
Ahmed S, Shellock FG: Magnetic resonance imaging safety: implications for cardiovascular patients. J Cardiovasc Magn Reson 2001;3:171–182.
Shellock FG, Crues JV: MR procedures: biologic effects, safety, and patient care. Radiology 2004;232:635–652.
Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC Jr, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO: ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003;108:1146–1162.
Flachskampf FA, Decoodt P, Fraser AG, Daniel WG, Roelandt JR: Guidelines from the Working Group. Recommendations for performing transesophageal echocardiography. Eur J Echocardiogr 2001;2:8–21.
Schmalz A, Erbel R, Wittlich N, Mohr-Kahaly S, Meyer J: Noninvasive quantification and classification of the severity of aortic stenosis using Doppler echocardiography. Z Kardiol 1992;81:619–626.
Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA: Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography. Circulation 1985;71:543–550.
Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ: Assessment of severity of aortic regurgitation using the width of the vena contracta: a clinical color Doppler imaging study. Circulation 2000;102:558–564.
Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ: Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777–802.
Devereux RB, Reichek N: Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977;55:613–618.
Hoffmann R, Flachskampf FA, Hanrath P: Planimetry of orifice area in aortic stenosis using multiplane transesophageal echocardiography. J Am Coll Cardiol 1993;22:529–534.
John AS, Dill T, Brandt RR, Rau M, Ricken W, Bachmann G, Hamm CW: Magnetic resonance to assess the aortic valve area in aortic stenosis: how does it compare to current diagnostic standards? J Am Coll Cardiol 2003;42:519–526.
Barkhausen J, Ruehm SG, Goyen M, Buck T, Laub G, Debatin JF: MR evaluation of ventricular function: true fast imaging with steady-state precession versus fast low-angle shot cine MR imaging: feasibility study. Radiology 2001;219:264–269.
Thiele H, Nagel E, Paetsch I, Schnackenburg B, Bornstedt A, Kouwenhoven M, Wahl A, Schuler G, Fleck E: Functional cardiac MR imaging with steady-state free precession (SSFP) significantly improves endocardial border delineation without contrast agents. J Magn Reson Imaging 2001;14:362–367.
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;i: 307–310.
Allison JD, Flickinger FW, Wright JC, Falls DG 3rd, Prisant LM, VonDohlen TW, Frank MJ: Measurement of left ventricular mass in hypertrophic cardiomyopathy using MRI: comparison with echocardiography. Magn Reson Imaging 1993;11:329–334.
Bellenger NG, Francis JM, Davies CL, Coats AJ, Pennell DJ: Establishment and performance of a magnetic resonance cardiac function clinic. J Cardiovasc Magn Reson 2000;2:15–22.
Longmore DB, Klipstein RH, Underwood SR, Firmin DN, Hounsfield GN, Watanabe M, Bland C, Fox K, Poole-Wilson PA, Rees RS, et al.: Dimensional accuracy of magnetic resonance in studies of the heart. Lancet 1985;i:1360–1362.
Mogelvang J, Stokholm KH, Saunamaki K, Reimer A, Stubgaard M, Thomsen C, Fritz-Hansen P, Henriksen O: Assessment of left ventricular volumes by magnetic resonance in comparison with radionuclide angiography, contrast angiography and echocardiography. Eur Heart J 1992;13:1677–1683.
Caruthers SD, Lin SJ, Brown P, Watkins MP, Williams TA, Lehr KA, Wickline SA: Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation 2003;108:2236–2243.
Friedrich MG, Schulz-Menger J, Poetsch T, Pilz B, Uhlich F, Dietz R: Quantification of valvular aortic stenosis by magnetic resonance imaging. Am Heart J 2002;144:329–334.
Kupfahl C, Honold M, Meinhardt G, Vogelsberg H, Wagner A, Mahrholdt H, Sechtem U: Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques. Heart 2004;90:893–901.
Garcia D, Pibarot P, Landry C, Allard A, Chayer B, Dumesnil JG, Durand LG: Estimation of aortic valve effective orifice area by Doppler echocardiography: effects of valve inflow shape and flow rate. J Am Soc Echocardiogr 2004;17:756–765.
Arsenault M, Masani N, Magni G, Yao J, Deras L, Pandian N: Variation of anatomic valve area during ejection in patients with valvular aortic stenosis evaluated by two-dimensional echocardiographic planimetry: comparison with traditional Doppler data. J Am Coll Cardiol 1998;32:1931–1937.
Beauchesne LM, deKemp R, Chan KL, Burwash IG: Temporal variations in effective orifice area during ejection in patients with valvular aortic stenosis. J Am Soc Echocardiogr 2003;16:958–964.
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